To the Editor: The report by Nishimura et al. (November 21 issue)1 that patients with mitral-valve prolapse whose echocardiographically determined left ventricular diastolic dimension was 60 mm or more were substantially more likely than patients with smaller ventricles to require mitral-valve replacement provides the first objective predictor of the most common complication of mitral-valve prolapse. Our own data support this observation. In our ongoing family study,2 during a mean follow-up of 4.5 years, complications due to mitral regurgitation occurred in 6 of 10 (60 percent) probands with mitral-valve prolapse whose initial left ventricular dimension was 60 mm or more, as.
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